Evaluating outcomes of stand-alone anterior lumbar interbody fusion: a systematic review

Abstract Background Stand-alone anterior lumbar interbody fusion (ALIF) is an effective surgical approach for selected spinal pathologies. It avoids the morbidity and complications associated with instrumented ALIF such as plate fixation and the traditionally used posterior approach. Despite improved disc space visualisation and clearance, the associated posterior instability and increased risk of non-fusion present major challenges to this approach. The integral cage design aims to address these challenges by providing the necessary stabilisation through intracorporeal screws. However, there is limited and controversial data available for stand-alone ALIF and integral cage fixation. To our knowledge, this is the first systematic review to evaluate recent findings on outcomes of stand-alone ALIF devices to explore areas of controversy and identify directions for future research. Methods Two reviewers conducted independent, systematic literature searches for appropriate studies in five electronic databases as per PRISMA guidelines. Studies were filtered using specified selection criteria, particularly exclusion of studies with supplementary fixation to ALIF and studies published before the year 2000. 17 studies met the criteria, and their data was comprehensively extracted and analyzed. Results The current literature is supportive of stand-alone ALIF due to acceptable clinical outcomes, promising fusion rates and disc height restoration. However, data and outcomes remain preliminary, and there are numerous areas of controversy. Conclusions